Plan Detail

Plan best suited – Available to all members of communicating for America.

Ages – 18 year to 64 years , their spouses and dependent children up to age 26.

Coverage: 30 days to upto 90 days.

Maximum Benefit: $2 Million is the maximum amount of covered charges that will be considered under the Secure STM plan per covered person, per coverage period

Secure STM is available to residents of ID, IN, KS, LA, ME, MD, MN, MT, NV and SD on an individual basis and not through CA. Therefore, membership is not required in these states

Pre-Existing -- Secure STM will not provide benefits for any loss caused by or resulting from a pre-existing condition. A pre-existing condition is any medical condition or sickness for which medical advice, care, diagnosis, treatment, consultation or medication was recommended or received from a doctor within five years immediately preceding the covered person effective date of coverage.

Benefits

Secure Lite plan selections

All benefits listed apply per covered person, per coverage period. Refer to the descriptions below the chart for additional benefit details.

Deductible
The selected deductible must be paid by the covered person before coinsurance benefits begin. Family deductible maximum is three individual deductible amounts.

$1,000

$2,500

$5,000

Coinsurance percentage and out-of-pocket
After the deductible has been met, the Secure Lite plan pays the selected percentage of covered charges. The covered person is responsible for the remaining percentage of covered charges until the selected out-of-pocket amount has been reached.
The out-of-pocket amount is specific to charges applied to coinsurance; it does not include the deductible.

20% coinsurance

Out-of-pocket:

$2,000

50% coinsurance

Out-of-pocket:

$5,000

Coverage-period maximum benefit

$750,000

Secure STM plan selections

All benefits listed apply per covered person, per coverage period. Refer to the descriptions below the chart for additional benefit details.

Deductible
The selected deductible must be paid by the covered person before coinsurance benefits begin. Family deductible maximum is three individual deductible amounts.

$1,000

$2,500

$5,000

Coinsurance percentage and out-of-pocket
After the deductible has been met, the Secure STM plan pays the selected percentage of covered charges. The covered person is responsible for the remaining percentage of covered charges until the selected out-of-pocket amount has been reached.
The out-of-pocket amount is specific to charges applied to coinsurance; it does not include the deductible.

20% coinsurance

Out-of-pocket:

$2,000

50% coinsurance

Out-of-pocket:

$5,000

Coverage-period maximum benefit

$2,000,000

Family deducticle

When three covered family members each meet their deductible, the deductibles for any remaining covered family members are considered met for the rest of the coverage period.

Coinsurance percentage and out-of-pocket

Once the deductible and coinsurance out-of-pocket amounts have been paid, additional covered charges within the coverage period are paid at 100 percent, up to the maximum benefit. The coinsurance out-of-pocket does not include any precertification penalty amounts or expenses not covered by the plan. Benefit-specific maximums may apply.

Payment options

Utilize a network provider and save

With a Secure STM plan, you have access to discounted medical services through two national preferred provider organizations (PPOs. These network providers have agreed to negotiated prices for their services and supplies. While you have the flexibility to choose any healthcare provider, the discounts available through network providers for covered services may help to lower your out-of-pocket costs.

MultiPlan—www.multiplan.com

One of the nation’s largest networks, MultiPlan has more than 650,000 providers in 50 states, including physicians, and inpatient and outpatient facilities.

ACS—www.anci-care.com

A comprehensive network of 38,000 ancillary service providers, ACS represents providers of outpatient services, including lab and diagnostic testing, but it does not include physicians.

To search for a network healthcare provider or facility, please visit the websites listed above. At the time of service, simply present your identification card which will include the network information needed for the provider to correctly process covered charges.

MultiPlan and ACS are not affiliated with Standard Security Life Insurance Company of New York, nor are they part of this insurance plan.

Covered expenses

All benefits are subject to the selected plan deductible and coinsurance. Covered expenses are limited by the Usual, Reasonable and Customary Charge as well as any benefit-specific maximum. If a benefit-specific maximum does not apply to the covered expense, benefits are limited by the coverage-period maximum.

Covered expenses include treatment, services and supplies for:

Doctor services for treatment and diagnosis

X-ray exams, laboratory tests and analysis

Mammography, Pap smear and prostate antigen test (covered at specific age intervals, not subject to the deductible)

Knee injury or disorder, up to $2,500 per coverage period for both left and right knees

Gallbladder surgery, up to $2,500 per coverage period

Osteoporosis for services related to diagnosis, treatment, and appropriate management of osteoporosis,

Prostate Cancer for screening and diagnosis,

Severe Mental Illness – The coinsurance percentage for diagnosis and medically necessary treatment of severe mental illnesses of a covered person of any age and of “serious emotional disturbances” of a child under the age of 18 years, to include out-patient, in-patient and partial hospital services.

Child dental care for general anesthesia and associated facility charges for dental procedures rendered in a Hospital or surgical center setting

Temporomandibular and Craniomandibular Joint Disease (TMJ/CMJ) for treatment of TMJ or CMJ when said treatment has been determined by the attending physician as being Medically Necessary. This provision does not include dental treatment.

Clinical trials for cancer

Preventive child care

Pre-existing condition limitation

Secure STM will not provide benefits for any loss caused by or resulting from a pre-existing condition. A pre-existing condition is any medical condition or sickness for which medical advice, care, diagnosis, treatment, consultation or medication was recommended or received from a doctor within 6 months immediately preceding the covered person’s effective date of coverage; or symptoms within the 6 months immediately prior to the coverage that would cause a reasonable person to seek diagnosis, care or treatment.

Usual, Reasonable and Customary Charge

The Usual, Reasonable and Customary Charge for medical services or supplies is the lesser of: a) the amount usually charged by the provider for the service or supply given; or b) the average charged for the service or supply in the locality in which it is received.

With respect to treatment of medical services, Usual, Reasonable and Customary means treatment that is reasonable in relationship to the service or supply given and the severity of the condition. In reaching a determination as to what amount should be considered as Usual, Reasonable and Customary, we may use and subscribe to a standard industry reference source that collects data and makes it available to its member companies.